Efficacy of Reverse and Modified Bohlman Technique for Lumbar Spondylolisthesis: A Systematic Review of the Literature

Objective: High-grade lumbar spondylolisthesis (HGLS) remains a challenging surgical entity, and there is no current consensus regarding optimal surgical approach. The purpose of this study was to systematically review the literature for studies utilizing the reverse or modified Bohlman technique for the treatment of HGLS to assess their safety and efficacy.

Methods: The authors performed a literature search of PubMed/MEDLINE electronic databases from their inception according to the PRISMA guidelines.

Results: A total of 8 studies were included. The studies comprised a total of 43 patients, with mean age of 41.4 ± 19.8 (range: 9-83) years. The mean follow-up was 38.2 ± 41.7 (range: 3-137) months. Most patients (81.4%) were classified as having grade III or higher spondylolisthesis. The most common presenting symptom was back pain (93%), followed by radiculopathy in roughly half of patients (41.9%). The majority of patients (93%) experienced complete resolution of symptoms as well as successful fusion (90.7%) on follow-up. Complications included cage/graft failure (7%), nerve injury (7%), wound infection (7%), pseudoarthrosis (2.3%), epidural hematoma (2.3%), and deep vein thrombosis (2.3%). Revision surgery was required in 4 (9.3%) patients. Slip percentage (60.2% vs. 43.2%, P < 0.0001) and slip angle (17.1° vs. 6.4°, P < 0.001) both decreased significantly following surgery.

Conclusions: Our data demonstrate that reverse and modified Bohlman techniques appear to be effective in both improving slip angle/percentage and relieving symptoms with low risk of complications. These findings are limited by the small sample size of patients. The authors recommend larger series before formal recommendations can be made.